Provider Demographics
NPI:1073731865
Name:FELLOWSHIP MEDICAL ADULT DAY CARE CENTER, INC.
Entity Type:Organization
Organization Name:FELLOWSHIP MEDICAL ADULT DAY CARE CENTER, INC.
Other - Org Name:FELLOWSHIP ADULT DAY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:HEE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:301-933-2500
Mailing Address - Street 1:4011 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1054
Mailing Address - Country:US
Mailing Address - Phone:301-933-2500
Mailing Address - Fax:301-942-6992
Practice Address - Street 1:18901 WARING STATION RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1906
Practice Address - Country:US
Practice Address - Phone:301-916-4141
Practice Address - Fax:301-916-0262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17184261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care